Interobserver Reliability of the Prism and Alternate Cover Test in Children With Esotropia

Holmes, Jonathan M.; Chandler, Danielle L.; Christiansen, Stephen P.; Birch, Eileen E.; Bothun, Erick D.; Laby, Daniel M.; Melia, B. Michele; Repka, Michael X.; Silbert, David I.; Zeto, V. Lori

doi:10.1001/archophthalmol.2008.548

Cited by 58 publications

(23 citation statements)

References 9 publications

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“…Nusz and colleagues, 18 using population-based methodology and defining deterioration as an increase in exotropic angle of 10 Δ or more, reported a Kaplan-Meier rate of deterioration of 23.1% at 5 years and 52.8% at 20 years. Subsequent work on variability of measurements of strabismus angle 19 found that the 95% limits of agreement for a difference between two prism and alternate cover tests in children with 20 Δ or greater esotropia were ±10.4 Δ at distance and ±11.7 Δ at near, suggesting that some of the changes reported by Nusz and colleagues 18 may have been within test–retest variability. Nevertheless, data on test–retest variability of angle of deviation in intermittent exotropia are not readily available.…”

Section: Discussionmentioning

confidence: 96%

Stability of near stereoacuity in childhood intermittent exotropia

Holmes

Leske

Hatt

et al. 2011

Journal of American Association for Pediatric Ophthalmology and

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Purpose To investigate the course of near stereoacuity in a cohort of children with untreated intermittent exotropia. Methods A total of 95 children aged 2 to 16 years with untreated intermittent exotropia were identified who had measurements of near stereoacuity, using the Preschool Randot (PSR) test on at least two successive examinations, with no intervening treatment. Deterioration was defined as a drop of at least 3 octaves, based on test–retest data. Alternative secondary analyses were performed defining deterioration as a drop of at least 2 octaves or as a transition from normal to subnormal. The main outcome measure was the deterioration rate calculated at 1 and 2 years using a Kaplan-Meier survival analysis. Results For near stereoacuity, the rate of decreasing 3 or more octaves was 2% (95% CI, 0%-6%) at 1 year and 7% (95% CI, 0%-16%) at 2 years. The alternative secondary analyses revealed similar low deterioration rates. In most cases of apparent deterioration, near stereoacuity returned to baseline levels without treatment. Conclusions For children with untreated intermittent exotropia, deterioration in near stereoacuity at 1 and 2 years is infrequent. Therefore, performing surgery for intermittent exotropia to proactively prevent deterioration of near stereoacuity cannot be justified. Retesting stereoacuity is critical to determine whether any measured decrease in stereoacuity is real.

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Section: Discussionmentioning

confidence: 96%

Stability of near stereoacuity in childhood intermittent exotropia

Holmes

Leske

Hatt

et al. 2011

Journal of American Association for Pediatric Ophthalmology and

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“…Previous studies have found the repeatability of the alternate cover test decreases for examiners testing strabismic subjects. 8,9 It is possible that the differences between experienced and inexperienced examiners would have been greater if a larger percentage of subjects with strabismus were included in the study. In addition, all the subjects in this study were cooperative adults, and it is possible the results may have differed had young children been included as cover test patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of Examiner Experience and Technique on the Alternate Cover Test

Anderson¹,

Manny²,

Cotter³

et al. 2010

Optometry and Vision Science

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Purpose To compare the repeatability of the alternate cover test between experienced and inexperienced examiners and the effects of dissociation time and examiner bias. Methods Two sites each had an experienced examiner train 10 subjects (inexperienced examiners) to perform short and long dissociation time alternate cover test protocols at near. Each site conducted testing sessions with an examiner triad (experienced examiner and two inexperienced examiners) who were masked to each other’s results. Each triad performed the alternate cover test on 24 patients using both dissociation protocols. In an attempt to introduce bias, each of the paired inexperienced examiners was given a different graph of phoria distribution for the general population. Analysis techniques that adjust for correlations introduced when multiple measurements are obtained on the same patient were used to investigate the effect of examiner and dissociation time on each outcome. Results The range of measured deviations spanned 27.5 prism diopters (Δ) base-in to 17.5Δ base-out. The absolute mean difference between experienced and inexperienced examiners was 2.28 ± 2.4Δ and at least 60% of differences were ≤2Δ. Larger deviations were measured with the long dissociation protocol for both experienced and inexperienced examiners (mean difference range = 1.17 to 2.14Δ, p < 0.0001). The percentage of measured small deviations (2Δ base-out to 2Δ base-in) did not differ between inexperienced examiners biased with the narrow vs. wide theoretical distributions (p = 0.41). The magnitude and direction of the deviation had no effect on the size of the differences obtained with different examiners or dissociation times. Conclusions Although inexperienced examiners differed significantly from experienced examiners, most differences were <2Δ suggesting good reliability of inexperienced examiners’ measurements. Examiner bias did not have a substantial effect on inexperienced examiner measurements; however, increased dissociation resulted in larger measured deviations for all examiners.

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“…The preoperative phoric status is the The heterophoric status of these patients was improved after cataract surgery. The difference of deviations was small, which could be an inherent error of prism and alternate cover tests [23,24]. However, this small change becomes meaningful when regarding patients themselves.…”

Section: Discussionmentioning

confidence: 91%